Varying tissue compression with an anvil configuration

ABSTRACT

The present disclosure relates to surgical fastener applying apparatus and the application of variable compression to tissue. More specifically, the presently disclosed surgical fastener applying apparatus act to limit the flow of blood through tissue immediately adjacent a cut-line formed therein to effectuate hemostasis, while maximizing the flow of blood through tissue more removed from the cut-line to limit unnecessary necrosis. In one embodiment, a surgical fastener applying apparatus is disclosed having a tool assembly coupled to a distal end thereof with first and second jaws respectively including an anvil and a surgical fastener cartridge. The surgical fastener cartridge includes, among other things, angled pushers that engage surgical fasteners of varying lengths.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.12/427,796, filed on Apr. 22, 2009, which claims the benefit of, andpriority to, U.S. Provisional Patent Application Ser. No. 61/051,916,filed on May 9, 2008, the entire contents of each of these priorapplications are incorporated by reference herein.

BACKGROUND

1. Technical Field

The present disclosure relates to surgical fastener applying apparatus.More particularly, the present disclosure relates to a tool assembly foruse with a surgical fastener applying apparatus, and methods ofmanufacturing the same, to apply a plurality of surgical fasteners totissue with varying compressive forces.

2. Background of the Related Art

Many varieties of surgical fastener applying apparatus are known in theart, some of which are specifically adapted for use in various surgicalprocedures including, but not limited to, end-to-end anastomosis,circular end-to-end anastomosis, open gastrointestinal anastomosis,endoscopic gastrointestinal anastomosis, and transverse anastomosis.Suitable examples of apparatus which may be used during the course ofthese procedures can be seen in U.S. Pat. Nos. 5,915,616; 6,202,914;5,865,361; and 5,964,394.

In general, a surgical fastener applying apparatus will include an anvilthat is approximated relative to a surgical fastener cartridge duringuse. The anvil includes depressions that are aligned with, and/or are inregistration with, slots defined in the surgical fastener cartridge,through which the surgical fasteners will emerge. To effectuateformation, the surgical fasteners emerge from the surgical fastenercartridge and are driven against the anvil. The surgical fastenercartridge typically has one or more rows of surgical fasteners that aredisposed laterally outward of a slot that is configured to accommodate aknife, or other such cutting element, such that tissue can besimultaneously severed and joined together at a cut-line. Depending uponthe particular surgical fastener applying apparatus, the rows offasteners may be arranged in a linear, non-linear, e.g. circular,semi-circular, or other configuration.

Various types of surgical fasteners are well known in the art including,but not limited to, unitary fasteners and two-part fasteners. Unitaryfasteners generally include a pair of legs that are adapted to penetratetissue and connected by a backspan from which they extend. In use,subsequent to formation, certain types of unitary fasteners have a “B”shaped configuration. Typically, the two-part fastener includes legsthat are barbed and connected by a backspan. The legs are engaged andlocked into a separate retainer piece that is usually located in theanvil. In use, the two-part fastener is pressed into the tissue so thatthe barbs penetrate the tissue and emerge from the other side where theyare then locked into the retainer piece. The retainers prevent thetwo-part fastener from dislodging from the tissue. The two-partfasteners are not intended to be unlocked or removable. For this reason,they are generally made of a bioabsorbable material.

A common concern in each of the procedures mentioned above ishemostasis, or the rate at which bleeding of the target tissue isstopped. It is commonly known that by increasing the amount of pressureapplied to a wound, the flow of blood can be limited, thereby decreasingthe time necessary to achieve hemostasis. To this end, conventionalsurgical fastener applying apparatus generally apply two or more rows offasteners about the cut-line to compress the surrounding tissue in aneffort to stop any bleeding and to join the cut tissue together. Each ofthe surgical fasteners will generally apply a compressive force to thetissue that is sufficient to effectuate hemostasis. However, applyingtoo much pressure can result in a needless reduction in blood flow tothe tissue surrounding the cut-line, resulting in an elevated level ofnecrosis, a slower rate of healing, and/or a greater recovery period.

Consequently, it would be advantageous to provide a surgical fastenerapplying apparatus capable of limiting the flow of blood in the tissueimmediately adjacent the cut-line to effectuate hemostasis and woundclosure, while maximizing blood flow in the surrounding tissue tofacilitate healing. Additionally, when tissue is clamped and compressedbetween the anvil and cartridge, some of the fluid retained within thetissue is squeezed out, which results in greater compression at theportions of the cartridge and the anvil adjacent the cut-line whencompared to the lateral edges. It may also be desirable to cut andfasten across tissue that varies in thickness. It would therefore beadvantageous to provide fasteners and surgical fastener applyingapparatus that are better adapted to apply variable compressive forcesto tissue in the interests of addressing these concerns.

SUMMARY

The present disclosure relates to surgical fastener applying apparatusthat apply variable compression to tissue, and/or accommodate tissue ofvarying thickness. More specifically, surgical fastener applyingapparatus in accordance with the principles of the present disclosureact to limit the flow of blood through tissue immediately adjacent acut-line formed therein to effectuate hemostasis, while maximizing theflow of blood through tissue more removed from the cut-line to limitunnecessary necrosis.

In one aspect of the present disclosure, a surgical fastener applyingapparatus is disclosed that includes an anvil member having a tissuecontacting surface, a surgical fastener cartridge, or cartridge member,that is movably coupled to the anvil member, and a sled.

The cartridge member extends along a longitudinal axis, and is movablycoupled to the anvil member. The cartridge member includes a pluralityof surgical fasteners and a plurality of pushers that are operativelyassociated with the plurality of surgical fasteners. Each pusherincludes a base portion and a plurality of pusher plates that extendfrom the base portion such that adjacent pusher plates define an acuteangle therebetween.

The aforementioned sled is operably engagable with the plurality ofpushers such that engagement of the sled with the pushers urges thesurgical fasteners towards the anvil member such that a first row ofsurgical fasteners applies a first compressive force to tissue disposedbetween the anvil member and the cartridge member, and a second row ofsurgical fasteners applies a second, different compressive force to thetissue disposed between the anvil member and the cartridge member.

The pushers and the surgical fasteners may be configured and dimensionedsuch that the compressive forces are varied along an axis that istransverse to the longitudinal axis of the cartridge member.Additionally, or alternatively, the pushers and the surgical fastenersmay be configured and dimensioned such that the compressive forcesapplied to the tissue decrease outwardly relative to a centerline of thecartridge member such that blood flow through the tissue nearer to thecenterline of the cartridge member is less than blood flow through thetissue further from the centerline of the cartridge member.

Each pusher plate extends from the base portion to define a differentlength. For example, the pusher plates positioned nearer to a centerlineof the cartridge member may be shorter than those positioned furtherfrom the centerline.

In one embodiment of the surgical fastener applying apparatus, theplurality of pusher plates includes a first pusher plate, a secondpusher plate, and a third pusher plate. In this embodiment, the firstpusher plate is positioned nearest to the centerline of the cartridgemember, the second pusher plate is positioned outwardly of the firstpusher plate and further from the centerline, and the third pusher plateis positioned outwardly of the second pusher plate and furthest from thecenterline. The first pusher plate extends from the base portion todefine a first length, the second pusher plate extends from the baseportion to define a second length, and the third pusher plate extendsfrom the base portion to define a third length, wherein the third lengthis greater than the second length, and the second length is greater thanthe first length.

The pusher plates are connected to the base portion at a hinge member,e.g., a living hinge. The hinge member is configured to allow the pusherplates to diverge as the pushers are driven towards the anvil member bythe sled such that the angles described between adjacent pusher platesare increased.

The disclosed cartridge member includes a top wall having a plurality ofretention slots formed therein that are configured and dimensioned toallow the surgical fasteners to pass therethrough during ejection fromthe cartridge member. Each fastener retention slot is aligned with acorresponding pocket formed in the tissue contacting surface of theanvil member. The fastener pockets formed in the tissue contactingsurface of the anvil member may be arranged such that each fastenerretention slot is aligned with a plurality of corresponding fastenerpockets to reduce any likelihood of improper surgical fastenerformation. In one embodiment, it is contemplated that the anvil membermay be formed from a plurality of plates that are secured together.

The surgical fasteners are positioned within the cartridge member todefine a predetermined distance between penetrating tips thereof and thecorresponding pocket formed in the tissue contacting surface of theanvil member. The surgical fasteners positioned nearer to a centerlineof the cartridge member may be shorter than the surgical fastenerspositioned further from the centerline such that the distance definedbetween the penetrating tips of the surgical fasteners and thecorresponding pockets formed in the tissue contacting surface of theanvil member varies with the distance between the surgical fasteners andthe centerline of the cartridge member. For example, it is envisionedthat the distance defined between the penetrating tips of the surgicalfasteners and the corresponding pockets formed in the tissue contactingsurface of the anvil member may increase with the distance between thesurgical fasteners and the centerline of the cartridge member.

In one embodiment of the surgical fastener applying apparatus, theplurality of surgical fasteners includes a plurality of first surgicalfasteners that are arranged into first rows, second rows, and thirdrows. In this embodiment, the first rows are positioned nearer to acenterline of the cartridge member, the second rows are positionedoutwardly of the first rows and further from the centerline, and thethird rows are positioned outwardly of the second rows and furthest fromthe centerline.

In another aspect of the present disclosure, a surgical fastenerapplying apparatus is disclosed that includes an anvil member, acartridge member extending along a longitudinal axis that is movablycoupled to the anvil member and configured and dimensioned to retain aplurality of surgical fasteners therein, and one or more pushers thatare movably positioned within the cartridge member to eject theplurality of surgical fasteners from the cartridge member into the anvilmember to effectuate formation of the plurality of surgical fastenerssuch that at least two different compressive forces are applied totissue.

The at least one pusher includes a base portion and a plurality ofpusher plates that are connected to the base portion such that theplurality of pusher plates are repositionable relative to a centerlineof the cartridge member during movement of the at least one pusher. Inone embodiment, it is envisioned that the pusher plates may extend fromthe base portion such that adjacent pusher plates define an acute angletherebetween. Additionally, or alternatively, it is envisioned that thepusher(s) may be of unitary construction, and/or that each pusher platemay extend from the base portion to define a different length.

Additionally, it is envisioned that the pusher(s) and the surgicalfasteners may be configured and dimensioned such that the compressiveforces applied to the tissue are varied along an axis that is transverseto the longitudinal axis of the cartridge member.

These and other features of the surgical access apparatus disclosedherein will become more readily apparent to those skilled in the artthrough reference to the detailed description of various embodiments ofthe present disclosure that follows.

BRIEF DESCRIPTION OF THE DRAWINGS

Various embodiments of the present disclosure are described hereinbelowwith references to the drawings, wherein:

FIG. 1 is a top, perspective view of a surgical fastener applyingapparatus having a tool assembly at a distal end thereof for applying aplurality of surgical fasteners to tissue, according to one embodimentof the present disclosure;

FIG. 2 is a side, perspective view of an exemplary surgical fastener;

FIG. 3 is a partial, perspective view of the tool assembly seen in FIG.1, with parts separated, illustrating an anvil and a surgical fastenercartridge assembly including a surgical fastener cartridge incorporatingangled pushers;

FIG. 4 is a schematic, enlarged view of the area of detail indicated inFIG. 3 illustrating a tissue contacting surface of the anvil and aplurality of fastener pockets formed therein;

FIG. 5 is a longitudinal, cross-sectional view taken along line 5-5 inFIG. 4 illustrating the fastener pockets formed in the tissue contactingsurface of the anvil;

FIG. 5A is a lateral, cross-sectional view of an alternative embodimentof the tool assembly seen in FIG. 1 taken through the fastener pocketsformed in the anvil and retention slots formed in the surgical fastenercartridge;

FIG. 6 is a lateral, cross-sectional view of the tool assembly seen inFIG. 1 taken through the fastener pockets formed in the anvil andretention slots formed in the surgical fastener cartridge;

FIG. 7 is a side, perspective view of the surgical fastener shown inFIG. 2 exhibiting a standard “B” shaped configuration subsequent toformation through engagement with the fastener pockets formed in theanvil seen in FIG. 3;

FIG. 8 is side, perspective view of a surgical fastener having asingle-loop configuration subsequent to formation through contact withthe fastener pockets formed in the tissue contacting surface included inan alternative embodiment of the anvil seen in FIG. 3;

FIG. 9A is a side, plan view of one embodiment of the surgical fastenershown in FIG. 2 including legs having a first length and shown prior toformation;

FIG. 9B is a cross-sectional view of the surgical fastener shown in FIG.9A subsequent to formation within adjacent tissue segments to apply afirst compressive force thereto;

FIG. 10A is a side view of another embodiment of the surgical fastenershown in FIG. 2 including legs having a second, shorter length and shownprior to formation;

FIG. 10B is a cross-sectional view of the surgical fastener shown inFIG. 10A subsequent to formation within adjacent tissue segments toapply a second, greater compressive force thereto;

FIG. 11A is a side view of still another embodiment of the surgicalfastener shown in FIG. 2 including legs having a third, shorter lengthand shown prior to formation;

FIG. 11B is a cross-sectional view of the surgical fastener shown inFIG. 11A subsequent to formation within adjacent tissue segments toapply a third, greater compressive force thereto;

FIG. 12 is a partial, longitudinal, perspective view, with partsremoved, of the surgical fastener cartridge seen in FIG. 3 illustratingthe plurality of surgical fasteners arranged into inner, intermediate,and outer rows;

FIG. 13 illustrates an end-to-end anastomosis device for use withalternative embodiments of the anvil and the surgical fastener cartridgeseen in FIG. 3;

FIG. 14 illustrates a surgical fastener applying instrument for use withalternative embodiments of the anvil and the surgical fastener cartridgeseen in FIG. 3;

FIG. 15 illustrates a transverse anastomosis fastener applyinginstrument for use with alternative embodiments of the anvil and thesurgical fastener cartridge seen in FIG. 3;

FIG. 16 is a lateral, cross-sectional view of an alternative embodimentof the tool assembly seen in FIG. 1 taken through the fastener pocketsformed in the anvil and retention slots formed in the surgical fastenercartridge in accordance with yet another embodiment of the presentdisclosure;

FIG. 17 is perspective view of a plurality of anvil plates, with partsseparated, in accordance with still another embodiment of the presentdisclosure; and

FIG. 18 is a perspective view of the plurality of anvil plates seen inFIG. 17 after assembly.

DETAILED DESCRIPTION OF THE EMBODIMENTS

Various embodiments of the presently disclosed surgical fastenerapplying apparatus, and methods of using the same, will now be describedin detail with reference to the drawings wherein like referencescharacters identify similar or identical elements. In the drawings, andin the description which follows, the term “proximal” will refer to theend the surgical fastener applying apparatus, or component thereof, thatis closest to the clinician during use, while the term “distal” willrefer to the end that is furthest from the clinician, as is traditionaland conventional in the art. In addition, the term “surgical fastener”should be understood to include any substantially rigid structure thatis suitable for the intended purpose of joining tissue together,including but not being limited to surgical staples, clips, and thelike.

FIG. 1 illustrates a surgical fastener applying apparatus 1000, ofeither the re-usable or disposable variety, including a handle assembly1002, with a movable handle 1003 _(A) and a stationary handle 1003 _(B),that is operatively connected to a tool assembly 1004 through a distallyextending elongated shaft 1006. In various embodiments, the handleassembly 1002 may be manually operated, and either additionally oralternatively, may include motorized, hydraulic, ratcheting, or othersuch mechanisms. In general, the tool assembly 1004 is adapted to clamp,fasten together, and sever adjacent tissue segments along a cut-line.

Referring now to FIGS. 2-6 as well, the tool assembly 1004 includes afirst jaw 1008 that is pivotally coupled to a second jaw 1010 tofacilitate approximation thereof. The first jaw 1008 of the toolassembly 1004 includes an anvil 1100, and the second jaw 1010 includes asurgical fastener cartridge assembly 1200 that is loaded with aplurality of surgical fasteners 100 (FIGS. 2, 3). Pivoting the movablehandle 1003 _(A) towards the stationary handle 1003 _(B) (FIG. 1)approximates the first jaw 1008 and the second jaw 1010. After the jaws1008, 1010 are in close operative alignment, continued pivoting of themovable handle 1003 _(A) ejects the plurality of surgical fasteners 100(FIG. 3) from the surgical fastener cartridge assembly 1200 such thatthe surgical fasteners 100 are driven into the anvil 1100, thus beingformed into completed surgical fasteners, as described in further detailbelow. The tool assembly 1004 and/or the surgical fastener cartridgeassembly 1200 may comprise a removable and replaceable loading unit forthe surgical fastener applying apparatus 1000.

As best seen in FIG. 2, each surgical fastener 100 includes two legs 102that are connected by a backspan 104 extending therebetween. The legs102 extend from the backspan 104 to penetrating ends 106 to define alength “L” prior to formation. The dimensions of the backspan 106 andthe legs 102 can be varied such that the surgical fasteners 100 may beused to fasten tissue having varying attributes, e.g., to fasten tissueof varying thickness, and/or to accommodate the presence of scar tissue.The dimensions of the legs 102 and the backspan 104 can be varied suchthat the surgical fasteners 100 can apply varying amounts of pressure totissue.

The legs 102 and the backspan 104 may define a cross-section having anysuitable geometric configuration including, but not limited to,rectangular, oval, square, triangular, trapezoidal, etc. The legs 102and the backspan 104 may exhibit the same geometrical configuration, asshown in FIG. 2, or alternatively, the legs 102 and the backspan 104 mayexhibit different geometrical configurations. For example, the legs 102may exhibit a rectangular cross-section, whereas the backspan 104 mayexhibit an oval cross-section.

The penetrating ends 106 of the legs 102 may be tapered to facilitatethe penetration of tissue, or alternatively, the penetrating ends 106may not include a taper. In various embodiments, it is also envisionedthat the penetrating ends 108, 110 may define either a conical surface,or a flat surface.

Prior to formation, the legs 102 of each surgical fastener 100 mayextend from the backspan 104 such that they are substantially parallel.In the alternative, the legs 102 may converge or diverge from thebackspan 104.

Referring now to FIG. 3 in particular, the surgical fastener applyingapparatus 1000 also includes a knife member 1007 that is operativelyconnected to a drive beam 1012, as described in commonly assigned U.S.Pat. No. 7,398,908, currently assigned to Tyco Healthcare Group LP, thecontents of which are hereby incorporated by reference herein in itsentirety, and discussed in further detail below. The knife member 1007may be configured and dimensioned for simultaneous engagement with boththe anvil member 1100 and a cavity 1222 that is defined by the secondjaw 1010.

During use, the tool assembly 1004 is first actuated to clamp ontotissue by manipulating the movable handle 1003 _(A) to advance a controlrod (not shown) distally. Distal advancement of the control rod resultsin corresponding movement of the knife member 1007, and effectuatesapproximation of the anvil member 1100 and the surgical fastenercartridge assembly 1200. With tissue clamped between the anvil member1100 and the surgical fastener cartridge assembly 1200, the fasteners100 (FIGS. 2, 3) are fired from the surgical fastener applying apparatus1000 (FIG. 1) into the tissue. The movable handle 1003 _(A) is thenoperated again to further advance the knife member 1007.

Referring now to FIGS. 3-6, the anvil 1100 and the surgical fastenercartridge assembly 1200 of the tool assembly 1004 (FIG. 1) will bediscussed in further detail. The anvil 1100 is an elongated memberhaving a tissue contacting surface 1102 with a plurality of pockets 1104(FIG. 4) formed therein. Each of the pockets 1104 is positioned toreceive the legs 102 (FIG. 2) of the surgical fastener 100, and isconfigured to redirect the legs 102 to thereby form the surgicalfasteners 100. More particularly, in the embodiment of the anvil 1100seen in FIGS. 3-6, each pocket 1104 includes two forming surfaces 1106,1108 (FIGS. 4, 5) that extend into the anvil 1100, i.e., away from thetissue contacting surface 1102, to define a depth ‘D” (FIG. 5). Uponengagement of the legs 102 (FIG. 2) with the forming surfaces 1106,1108, the forming surfaces 1106, 1108 guide the legs 102 inwardly in thedirection of arrows “A” (FIG. 4) to facilitate deformation of thesurgical faster 100 into the standard “B” shaped configuration (FIG. 7).In an alternative embodiment, the anvil 1100 may include pockets 1104that are configured and dimensioned to deform the surgical fastener 100such that the surgical fastener 100 defines a single-loop configuration(FIG. 8) upon formation. It is also envisioned that the surgicalfastener 100 may exhibit other configurations upon formation.

The pockets 1104 are arranged into rows disposed on opposite sides of aslot 1110 extending at least partially through the anvil member 1100(FIGS. 3, 4). The slot 1110 is configured to accommodate longitudinalmovement of the knife member 1007 (FIG. 3) such that tissue may besevered along a cut-line. Although the slot 1110 is depicted asextending longitudinally through the anvil 1100, in alternativeembodiments, the slot 1110 may define a configuration that is angled,arcuate, or shaped otherwise. The slot 1110 may extend along acenterline of the anvil 1100, as shown in the embodiment illustrated inFIGS. 3 and 4, or alternatively, the slot 1110 may be spaced therefrom.

In the specific embodiment of the anvil 1100 seen in FIGS. 3-6, thepockets 1104 are arranged into a pair of outer rows 1112 _(A) (FIG. 4)that are spaced laterally outward of the slot 1110 and furthesttherefrom, a pair of intermediate rows 1112 _(B) that are spacedlaterally inward of the pair of outer rows 1112 _(A), and a pair ofinner rows 1112 _(C) that are spaced laterally inward of the pair ofintermediate rows 1112 _(B) and closest to the slot 1110. While theanvil 1100 is depicted as including three rows of pockets 1104, i.e.,the respective outer, intermediate, and inner rows 1112 _(A), 1112 _(B),1112 _(C), the arrangement of pockets 1104 into fewer or greater numbersof rows in alternative embodiments is also within the scope of thepresent disclosure. With reference to FIG. 5A, in one particularembodiment, the anvil 1100 includes additional rows of pockets 1104 toaccommodate for any lateral deflection experienced by the surgicalfasteners 100, i.e., towards or away from the slot 1110, as they aredeployed through the tissue grasped between the jaws 1008, 1010 (FIG. 1)of the tool assembly 1004. The surgical fasteners 100 may be deflectedlaterally, for example, due to the presence of scar tissue,irregularities in the tissue, or tissue of increased thickness. Byproviding additional rows of pockets 1104, the likelihood of engagementbetween the surgical fasteners 100 and one of the pockets 1104, andthus, proper fastener formation, is increased.

With continued reference to FIGS. 3-6, the surgical fastener cartridgeassembly 1200 will be discussed. In the particular embodiment seen inFIGS. 3 and 6, the surgical fastener cartridge assembly 1200 is loadedwith three varieties of surgical fastener, i.e., the surgical fasteners100 _(A), 100 _(B), 100 _(C) seen in FIGS. 9A-11B. In alternativeembodiments, however, the surgical fastener cartridge assembly 1200 mayinclude fewer or additional varieties of surgical fasteners 100.

Turning momentarily to FIGS. 9A-11B, it can be seen that the surgicalfasteners 100 _(A), 100 _(B), 100 _(C) are substantially identical butfor the respective lengths “L_(A),” “L_(B),” “L_(C)” defined by theirlegs 102 _(A), 102 _(B), 102 _(C). Specifically, the length “L_(B)”defined by the legs 102 _(B) of the surgical fasteners 100 _(B) is lessthan the length “L_(A)” defined by the legs 102 _(A) of the surgicalfasteners 100 _(A), and the length “L_(C)” defined by the legs 102 _(C)of the surgical fasteners 100 _(C) is less than the length “L_(B)”defined by the legs 102 _(B) of the surgical fasteners 100 _(B). Stateddifferently, the surgical fasteners 100 _(C) have the shortest legs 102_(C), and the surgical fasteners 100 _(A) have the longest legs 102_(A).

As seen in FIGS. 3 and 6, the surgical fastener cartridge assembly 1200includes a surgical fastener cartridge body 1202 extending along an axis“X-X” (FIG. 3) that houses, among other components, the surgicalfasteners 100 _(A), 100 _(B), 100 _(C) (FIGS. 9A-11B). A longitudinalslot 1204 extends through the surgical fastener cartridge body 1202 thatis configured and dimensioned to accommodate longitudinal movement ofthe knife 1007 (FIG. 3) such that tissue may be severed along theaforementioned cut-line. Although the slot 1204 is depicted as extendinglongitudinally through the surgical fastener cartridge body 1202, inalternative embodiments, the slot 1204 may define a configuration thatis angled, arcuate, or shaped otherwise. The slot 1204 may extend alonga centerline of the surgical fastener cartridge body 1202, as shown inthe embodiment illustrated in FIGS. 3 and 6, or alternatively, the slot1204 may be spaced therefrom.

The surgical fastener cartridge body 1202 is defined by a substantiallyplanar bottom wall 1206, a pair of side walls 1208, 1210 that extendupwardly therefrom, and a top wall 1212. The top wall 1212 is alsosubstantially planar, and extends in substantially parallel relation tothe bottom wall 1206. The top wall 1212 includes a tissue engagingsurface 1214, e.g., for maintaining the position of the tissue to becut. When the jaws 1008, 1010 (FIG. 1) of the tool assembly 1004 are inan approximated position, the tissue engaging surface 1214 of the topwall 1212 is spaced a distance “Y” (FIG. 6) from the tissue contactingsurface 1102 of the anvil 1100.

The tissue engaging surface 1214 of the top wall 1212 further includes aplurality of fastener retention slots 1216 formed therein. Each fastenerretention slot 1216 is configured and dimensioned to receive one of thesurgical fasteners 100 _(A), 100 _(B), 100 _(C) (FIGS. 6, 9A-11B). Todrive the surgical fasteners 100 _(A), 100 _(B), 100 _(C) upwardly,i.e., towards the top wall 1212, and through the fastener retentionslots 1216, the surgical fastener cartridge assembly 1200 furtherincludes a plurality of pushers 1218 (FIG. 3) and a sled 1220 that isdisposed within the cavity 1222 defined by the second jaw 1010 of thetool assembly 1004 (FIG. 1).

The pushers 1218 are positioned beneath the surgical fasteners 100 _(A),100 _(B), 100 _(C), and are configured to engage the sled 1220 as thesled 1220 traverses the cavity 1222 via translation of the drive beam1012, or other such actuation component. Each pusher 1218 includes aplurality of pusher plates, identified generally by the referencecharacter 1224, corresponding in number to the number of rows offastener lines desired within the tissue upon firing of the surgicalfastener applying apparatus 1000 (FIG. 1). Accordingly, in theembodiment seen in FIGS. 3 and 5, each pusher 1218 includes three pusherplates, i.e., outer, intermediate, and inner pusher plates 1224 _(A),1224 _(B), 1224 _(C), respectively. In alternative embodiments, however,it is envisioned that the pushers 1218 may include fewer or greaternumbers of pusher plates 1224 should the desired number of rows offastener lines be fewer or greater.

Each of the respective outer, intermediate, and inner pusher plates 1224_(A), 1224 _(B), 1224 _(C) extends upwardly from, and is connected to, abase portion 1226 of the pusher 1218 at one or more hinge members 1228.In one embodiment, as seen in FIG. 6 for example, the hinge member(s)1228 may comprise a living hinge formed integrally with the pusher 1218.The hinge member(s) 1228 permit the outer, intermediate, and innerpusher plates 1224 _(A), 1224 _(B), 1224 _(C) to diverge as the pushers1218 are driven upwardly by the sled 1220 (FIG. 3). The outer,intermediate, and inner pusher plates 1224 _(A), 1224 _(B), 1224 _(C)extend from the base portion 1226 in offset relation such that the outerpusher plate 1224 _(A) and the intermediate pusher plate 1224 _(B)subtend a first acute angle θ₁, while the intermediate pusher plate 1224_(B) and the outer pusher plate 1224 _(C) subtend a second acute angleθ₂.

In one particular embodiment, the pushers 1218 are unitary inconstruction, as shown in FIG. 6 for example, such that the pusherplates 1224 extend directly from the base portion 1226. For example, itis envisioned that the pusher plates 1224 may be integrally, e.g.,monolithically, formed with the base portion 1226. It is alsoenvisioned, however, that the pushers 1218 and the pusher plates 1224may constitute separate, discrete structures.

The outer, intermediate, and inner pusher plates 1224 _(A), 1224 _(B),1224 _(C) are configured and dimensioned to engage the surgicalfasteners 100 _(A), 100 _(B), 100 _(C), respectively. Consequently, thesurgical fasteners 100 _(A), 100 _(B), 100 _(C) are also arranged withinthe surgical fastener cartridge body 1202 in offset relation such thatthe surgical fasteners 100 _(A), 100 _(B) subtend the first acute angleθ₁ and the surgical fasteners 100 _(B), 100 _(C) subtend the secondacute angle θ₂.

The distance “D” measured from the pushers 1218 to the tissue contactingsurface 1102 of the anvil 1100 for each of the pushers 1218 issubstantially the same. While the height of each pusher 1218, measuredalong the vertical axis “Z-Z,” or height, of the surgical fastenercartridge 1200 is substantially the same, the offset relationshipbetween the respective outer, intermediate, and inner pusher plates 1224_(A), 1224 _(B), 1224 _(C) results in each pusher plate defining adifferent length. More specifically, in the embodiment seen in FIG. 6,the outer pusher plate 1224 _(A) defines a greater length than theintermediate pusher plate 1224 _(B), and the intermediate pusher plate1224 _(B) defines a greater length than the inner pusher plate 1224_(C). Stated differently, the pushers 1218 are arranged beneath thesurgical fasteners 100 _(A), 100 _(B), 100 _(C) such that shortestpusher plate, i.e., inner pusher plate 1224 _(C), is disposed closest tothe slot 1204 and beneath the shortest surgical fastener, i.e., thesurgical fastener 100 _(A), and the longest pusher plate, i.e., theouter pusher plate 1224 _(A), is disposed furthest from the slot 1204and beneath the longest surgical fastener, i.e., the surgical fasteners100 _(C).

The offset relationship between the respective outer, intermediate, andinner pusher plates 1224 _(A), 1224 _(B), 1224 _(C), and thecorresponding offset relationship between the surgical fasteners 100_(A), 100 _(B), 100 _(C), results in the definition of a variabledistance between the respective penetrating ends 106 _(A), 106 _(B), 106_(C) of the surgical fasteners 100 _(A), 100 _(B), 100 _(C) and thepockets 1104 formed in the tissue contacting surface 1102 of the anvil1100. More specifically, the penetrating ends 106 _(A) of the surgicalfasteners 100 _(A) are spaced a distance “X_(A)” from the pockets 1104comprising the pair of outer rows 1112 _(A) (FIG. 4), the penetratingends 106 _(B) of the surgical fasteners 100 _(B) are spaced a distance“X_(B)” from the pockets 1104 comprising the intermediate pair of rows1112 _(B), and the penetrating ends 106 _(C) of the surgical fasteners100 _(C) are spaced a distance “X_(C)” from the pockets 1104 comprisingthe inner pair of rows 1112 _(C). In the illustrated embodiment, thedistance ‘X_(A)” is less than the distance “X_(B),” and the distance“X_(B)” is less than the distance “X_(C).”

The fastener retention slots 1216 are arranged into pairs of outer,intermediate, and inner rows 1230 _(A), 1230 _(B), 1230 _(C) (FIG. 3)that correspond respectively to the pairs of outer, intermediate, andinner rows 1112 _(A), 1112 _(B), 1112 _(C) (FIG. 4) of pockets 1104formed in the tissue contacting surface 1102 of the anvil 1100, thusincreasing the likelihood of proper engagement between the surgicalfasteners 100 _(A), 100 _(B), 100 _(C) and the pockets 1104.Accordingly, upon ejection of the surgical fasteners 100 _(A), 100 _(B),100 _(C) from the fastener retention slots 1216, the surgical fasteners100 _(A) are directed into contact with the pockets 1104 comprising thepair of outer rows 1112 _(A), the surgical fasteners 100 _(B) aredirected into contact with the pockets 1104 comprising the pair ofintermediate rows 1112 _(B), and the surgical fasteners 100 _(C) aredirected into contact with the pockets 1104 comprising the pair inner ofrows 1112 _(C). In one embodiment, as seen in FIG. 6, the fastenerretention slots 1216 comprising the pairs of outer, intermediate, andinner rows 1230 _(A), 1230 _(B), 1230 _(C) may be connected at lead-ins1232, which may be radiused, as shown, or of any other suitableconfiguration, e.g., planar or pointed. Alternatively, however, it isenvisioned that the fastener retention slots 1216 comprising therespective outer, intermediate, and inner pairs of rows 1230 _(A), 1230_(B), 1230 _(C) may be discrete.

The pair of outer rows 1230 _(A) (FIGS. 3, 6) of fastener retentionslots 1216 are spaced laterally outward of the slot 1204 and aredisposed furthest therefrom, the pair of intermediate rows 1230 _(B) arespaced inwardly of the pair of outer rows 1230 _(A), and the pair ofinner rows 1230 _(C) are spaced inwardly of the pair of intermediaterows 1230 _(B) and are disposed closest to the slot 1204, each of therespective inner, intermediate, and outer pairs of rows 1230 _(A), 1230_(B), 1230 _(C) being arranged on opposite sides of the slot 1204.Consequently, as the surgical fasteners 100 _(A), 100 _(B), 100 _(C)exit the fastener retention slots 1216 and are formed within tissue, thesurgical fasteners 100 _(A), 100 _(B), 100 _(C) will be arranged torespectively define outer, intermediate, and inner fastener lines onopposite sides of the cut-line formed in the tissue. While the surgicalfastener cartridge body 1202 is depicted as including three pairs ofrows, i.e., the respective outer, intermediate, and inner rows 1230_(A), 1230 _(B), 1230 _(C), fewer and greater numbers of rows offastener retention slots 1216 may be included in alternative embodimentsof the surgical fastener cartridge assembly 1200.

With reference again to FIGS. 9A-9B, the surgical fasteners 100 _(A)will be discussed before and after formation. As seen in FIG. 9A, beforeformation, the legs 102 _(A) of the surgical fastener 100 _(A) define alength “L_(A)” that is measured from the penetrating ends 106 _(A) to anouter surface 108 _(A) of the backspan 104 _(A). After formation, thelegs 102 _(A) are configured such that the surgical fastener 100 _(A)defines, for example, the standard “B” shaped configuration (FIG. 9B).When formed within adjacent tissue segments “T₁,” “T₂,” the tissuesegments “T₁,” “T₂” are compressed and maintained in approximationbetween an inner surface 110 _(A) of the curved legs 102 _(A) and aninner surface 112 _(A) of the backspan 104 _(A) within a compressivespace 114 _(A). The compression of the tissue segments “T₁,” “T₂”creates a biasing force “B_(A)” in the tissue segments “T₁,” “T₂” thatendeavors to force the legs 102 _(A) of the surgical fastener 100 _(A)outwardly in the direction indicated by arrows 1. The legs 102 _(A)resist yielding, but their length “L_(A)” allows the legs 102 _(A) to bedeflected outwardly, albeit a minimal distance, under the influence ofthe biasing force “B_(A)” such that the compressive space 114 _(A)ultimately defines a dimension “C_(A).” Maintaining the tissue segments“T₁,” “T₂” within the compressive space 114 _(A) subjects the tissuesegments “T₁,” “T₂” to a corresponding compressive force “F_(A)” whichlimits, but does not completely restrict, the flow of blood through thetissue surrounding the surgical fastener 100 _(A). Thus, unnecessarynecrosing of the fastened tissue segments “T₁,” “T₂” may be prevented orimpeded.

With reference now to FIGS. 10A-10B, the surgical fastener 100 _(B) isshown before and after formation, respectively. Before formation, thelegs 102 _(B) define a length “L_(B)” that is measured from thepenetrating ends 106 _(B) to the outer surface 108 _(B) of the backspan104 _(B). The length “L_(B)” is less than the length “L_(A)” defined bythe legs 102 _(A) of the surgical fastener 100 _(A) illustrated in FIGS.9A-9B. After formation, the legs 102 _(B) are configured such that thesurgical fastener 100 _(B) also defines the standard “B” shapedconfiguration (FIG. 10B). When the surgical fastener 100 _(B) is formedwithin tissue segments “T₁,” “T₂,” the compressed tissue segments “T₁,”“T₂” exert a biasing force “B_(B)” that endeavors to force the legs 102_(B) outwardly in the direction indicated by arrows 1. The shorterlength “L_(B)” of the legs 102 _(B) allows the legs 102 _(B) to resistyielding to a greater extent than the legs 102 _(A) of the surgicalfastener 100 _(A) such that a compressive space 114 _(B) is ultimatelydefined with a dimension “C_(B)” that is smaller in comparison to thedimension “C_(A)” of the compressive space 114 _(A) illustrated in FIG.9B. The smaller dimension “C_(B)” of the compressive space 114 _(B)results in the application of a corresponding compressive force “F_(B)”to the tissue segments “T₁,” “T₂” that is greater than the compressiveforce “F_(A)” applied by the surgical fastener 100 _(A). Consequently,the flow of blood through the tissue surrounding the surgical fastener100 _(B) is further restricted when compared to the flow of bloodthrough the tissue surrounding the surgical fastener 100 _(A), therebyfurther facilitating hemostasis. The compressive force “F_(B)” does notcompletely restrict the flow of blood through the tissue surrounding thesurgical fastener 100 _(B), however. Thus, unnecessary necrosing of thefastened tissue segments “T₁,” “T₂” may be prevented or impeded.

FIGS. 11A-11B illustrate the surgical fastener 100 _(C) before and afterformation, respectively. Before formation, the legs 102 _(C) define alength “L_(C)” that is measured from the penetrating ends 106 _(C) tothe outer surface 108 _(C) of the backspan 104 _(C). The length “L_(C)”is less than the length “L_(B)” defined by the legs 102 _(B) of thesurgical fastener 100 _(B) illustrated in FIGS. 10A-10B. Afterformation, the legs 102 _(C) are configured such that the surgicalfastener 100 _(C) also defines the standard “B” shaped configuration(FIG. 11B). When the surgical fastener 100 _(C) is formed within tissuesegments “T₁,” “T₂,” the compressed tissue segments “T₁,” “T₂” exert abiasing force “B_(C)” that endeavors to force the legs 102 _(C)outwardly in the direction indicated by arrows 1. The shorter length“L_(C)” of the legs 102 _(C) allows the legs 102 _(C) to resist yieldingto a greater extent than the legs the legs 102 _(B) of the surgicalfastener 100 _(B) such that a compressive space 114 _(C) is ultimatelydefined with a dimension “C_(C)” that is smaller in comparison to thedimension “C_(B)” of the compressive space 114 _(B) illustrated in FIG.10B. The smaller dimension “C_(C)” of the compressive space 114 _(C)results in the application of a corresponding compressive force “F_(C)”to the tissue segments “T₁,” “T₂” that is greater than the compressiveforce “F_(B)” applied by the surgical fastener 100 _(B). Consequently,the flow of blood through the tissue surrounding the surgical fastener100 _(C) is further restricted when compared to the flow of bloodthrough the tissue surrounding the surgical fastener 100 _(B). Thecompressive force “F_(B)” applied to the tissue segments “T₁,” “T₂”substantially, if not completely restricts the flow of blood through thetissue surrounding the surgical fastener 100 _(C), thereby furtherfacilitating, and effectuating hemostasis.

The length “L_(A)” of the legs 102 _(A), the length “L_(B)” of the legs102 _(B), and the length “L_(C)” of the legs 102 _(C), as well as thecorresponding dimensions “C_(A),” “C_(B),” “C_(C)” of the compressivespaces 114 _(A), 114 _(B), 114 _(C) occupied by tissue segments “T₁,”“T₂” when the respective surgical fasteners 100 _(A), 100 _(B), 100 _(C)are in their formed conditions, may be altered or varied in differentembodiments of the present disclosure to effectuate any desired level ofhemostasis and blood flow in the tissue segments “T₁,” “T₂.”Furthermore, the size of the surgical fasteners 100 _(A), 100 _(B), 100_(C) may be substantially the same, or may vary within a row ofretention slots 1216, or in any other pattern.

Referring now to FIGS. 6 and 12, the pushers 1218 are arrangedlongitudinally on opposite sides of the slot 1204 extending through thesurgical fastener cartridge body 1202 such that the surgical fasteners100 _(A), 100 _(B), 100 _(C) define pairs of outer, intermediate, andinner rows 1234 _(A), 1234 _(B), 1234 _(C) that correspond respectivelyin position to the outer, intermediate, and inner rows 1230 _(A), 1230_(B), 1230 _(C) (FIG. 3) of fastener retention slots 1216. Accordingly,the surgical fasteners 100 _(A) comprising the pair of outer rows 1234_(A) will be spaced laterally outward, and furthest from, the cut-lineformed upon fastening, the surgical fasteners 100 _(B) comprising thepair of intermediate rows 1234 _(B) will be disposed inwardly of thesurgical fasteners 100 _(A) comprising the pair of outer rows 1234 _(A),and the fasteners 100 _(C) comprising the pair of inner rows 1234 _(C)will be disposed inwardly of the surgical fasteners 100 _(B) comprisingthe pair of intermediate rows 1234 _(B), along the cut-line, and closestthereto. The respective outer, intermediate, and inner rows 1234 _(A),1234 _(B), 1234 _(C) of surgical fasteners 100 _(A), 100 _(B), 100 _(C)will be applied to the tissue such that they define corresponding linesof fasteners on opposite sides of the cut-line.

The surgical fastener cartridge body 1202 seen in FIGS. 3, 6, and 12 isillustrated as including outer, intermediate, and inner rows 1234 _(A),1234 _(B), 1234 _(C) exclusively including the respective surgicalfasteners 100 _(A), 100 _(B), 100 _(C). In other words, each surgicalfastener disposed in a particular row will have the same configuration,i.e., legs of the same length. By arranging the surgical fasteners 100_(A), 100 _(B), 100 _(C) in this manner, the surgical fasteners with theshortest leg length resulting in the greatest compressive force, i.e.,surgical fasteners 100 _(C), are deployed closest to the cut-line, andthe surgical fasteners having longer legs and resulting in lessercompressive forces, i.e., surgical fasteners 100 _(A) and 100 _(B), areprovided further from the cut-line. Consequently, arranging the surgicalfasteners 100 _(A), 100 _(B), 100 _(C) in this way minimizes the flow ofblood through the tissue immediately adjacent the cut-line and graduallyincreases the flow of blood through the tissue spaced a greater lateraldistance therefrom. It should be appreciated that the length of the legscould be varied to accommodate tissue of different thicknesses and tocontrol tissue compression by the fasteners 100 _(A), 100 _(B), 100_(C).

In alternative embodiments of the present disclosure, it is envisionedthat the surgical fastener cartridge body 1202 may include outer,intermediate, and inner rows 1234 _(A), 1234 _(B), 1234 _(C) comprisinga combination of surgical fasteners 100 _(A), 100 _(B), 100 _(C) suchthat a particular row may include a variety of surgical fasteners havingdifferent configurations, e.g., legs of different lengths. By providinga variety of surgical fasteners in each row, the flow of blood throughthe tissue can be controlled longitudinally, along the cut-line, as welllaterally as the distance therefrom is varied.

With continued reference to FIG. 12, by loading the surgical fastenercartridge 1200 (FIG. 3) with a variety of surgical fasteners, e.g.,surgical fasteners 100 _(A), 100 _(B), 100 _(C), and by arranging thesurgical fasteners 100 _(A), 100 _(B), 100 _(C) such that those with theshortest legs, i.e., surgical fasteners 100 _(C), are closest to thecut-line and those with the longest legs, i.e., surgical fasteners 100_(A), are furthest from the cut-line, a greater range of tissuethickness can be effectively fastened, as the thickness of the tissuewill generally increase with the distance from the cut-line, e.g., as aresult of clamping by the tool assembly 1004 (FIG. 1). Accordingly,loading the surgical fastener cartridge 1200 with a variety of surgicalfasteners having legs of various lengths allows a single surgicalfastener cartridge 1200 to fasten tissue of varying thickness.

Referring now to FIGS. 1-6 and 9-12, a method of fastening tissue withthe surgical fastener applying apparatus 1000 (FIG. 1) will bediscussed. During use, the surgical fastener applying apparatus 1000 isapproximated and fired similarly to, and in accordance with other knownsurgical fastener applying apparatus, such as that disclosed in commonlyassigned U.S. Pat. No. 5,865,361, currently assigned to Tyco HealthcareGroup LP, the contents of which are hereby incorporated by referenceherein in its entirety.

The movable handle 1003 _(A) is operatively connected to an actuationshaft, which receives the proximal end of a control rod, such thatmanipulation of the movable handle 1003 _(A) results in linearadvancement of the actuation shaft, which causes corresponding linearadvancement of the control rod. An axial drive assembly is also providedthat is engagable with the control rod. More specifically, the axialdrive assembly includes the elongated drive beam 1012 (FIG. 3), whichincludes a distal end that supports the knife blade 1007, and a drivemember that is configured and dimensioned for engagement with thecontrol rod. As seen in FIG. 3, the knife 1007 is positioned totranslate behind the sled 1220.

After the surgical fastener applying apparatus 1000 (FIG. 1) ismanipulated to position the target tissue between the open jaws 1008,1010 (FIG. 1) of the tool assembly 1004, the jaws 1008, 1010 areapproximated using the handle assembly 1002 to clamp the target tissuetherebetween and apply a compressive force thereto. Specifically,manipulation of the movable handle 1003 _(A) advances the actuationshaft to effectuate corresponding advancement of the control rod. Sincethe control rod is connected at its distal end to the drive assembly,which includes the aforementioned drive beam 1113, distal movement ofthe control rod causes corresponding movement of the drive beam 1113,which in turn, forces the anvil 1100 towards the surgical fastenercartridge assembly 1200.

With the tissue securely clamped between the jaws 1008, 1010 (FIG. 1),the surgical fastener applying apparatus 1000 is then fired to eject thesurgical fasteners, e.g., the surgical fasteners 100 _(A), 100 _(B), 100_(C) (FIGS. 9A-11B). To fire the surgical fastener applying apparatus1000, the movable handle 1003 _(A) is again manipulated to causeadvancement of the drive assembly, which causes the sled 1220 (FIG. 3)to traverse the cartridge body 1202, and eject the plurality of surgicalfasteners 100 from the surgical fastener cartridge assembly 1200. Morespecifically, as the sled 1220 moves distally, it engages the pushers1218 (FIGS. 3, 6) to thereby drive the surgical fasteners 100 _(A), 100_(B), 100 _(C) upwardly, i.e., towards the top wall 1212 of the surgicalfastener cartridge body 1202. As the surgical fasteners 100 _(A), 100_(B), 100 _(C) are driven upwardly, the fastener retention slots 1216(FIGS. 3, 6) maintain the relative positions thereof.

After passing through the fastener retention slots 1216, the surgicalfasteners 100 _(A), 100 _(B), 100 _(C) pass through the tissue and areforced into engagement with the pockets 1104 formed in the tissuecontacting surface 1102 of the anvil 1100, thereby achieving, forexample, the formed configurations seen in FIGS. 9B, 10B, and 11B,respectively. Upon formation within the tissue, the surgical fasteners100 _(A), 100 _(B), 100 _(C) limit the blood flow through the tissueimmediately adjacent and surrounding the cut-line to thereby effectuatehemostasis, while permitting greater blood flow through the tissuespaced laterally therefrom to minimizing necrosing of the tissue, asdiscussed above.

While the tool assembly 1004 (FIG. 1) has been discussed in connectionwith the surgical fastener applying apparatus 1000, which is adapted foruse in laparoscopic procedures for performing surgical anastomoticfastening of tissue, the tool assembly 1004 may be adapted for use withany surgical instrument suitable for the intended purpose of applyingthe plurality of surgical fasteners, e.g., the surgical fasteners 100(FIG. 2), the surgical fasteners 100 _(A) (FIGS. 9A, 9B), the surgicalfasteners 100 _(B) (FIGS. 10A, 10B), and/or the surgical fasteners 100_(C) (FIGS. 11A, 11B), to a section of tissue, and thereafter, severingthe tissue along a cut-line.

For example, the tool assembly 1004 (FIG. 1) may be adapted for use withan end-to-end anastomosis (EEA) apparatus 2000 (FIG. 10), such as thatdisclosed in commonly assigned U.S. Pat. No. 7,455,676, currentlyassigned to Tyco Healthcare Group LP, the contents of which are herebyincorporated by reference herein in its entirety. The EEA apparatus 2000includes a handle assembly 2002 having at least one pivotable actuatinghandle member 2004, and advancing means 2006. Extending from handleassembly 2002, there is provided a tubular body portion 2008 thatterminates in a fastener ejection (tool) assembly 2010 having a circularfastener cartridge 2012 that is configured and dimensioned to retain aplurality of surgical fasteners therein. An anvil shaft 2014 operativelycouples an anvil assembly 2016 to the handle assembly 2002 such that theanvil assembly 2016 is repositionable from a location where it is inclose cooperative alignment with the fastener cartridge 2012 to alocation where it is spaced apart from the fastener staple cartridge2012.

The tool assembly 2010 includes a fastener ejection member that ispositioned within the fastener cartridge 2012. The fastener ejectionmember includes a distal portion defining concentric rings ofperipherally spaced staple pushers that are received within a respectivestaple retention slot to eject the surgical fasteners from the fastenercartridge 2012. The fastener ejection member is configured anddimensioned to be contacted by a distal end of a driver tube that isoperatively connected to the advancing means 2006 through the bodyportion 2008 such that manipulation of the advancing means effectuatesadvancement of the driver tube to force the staple pushers intoengagement with the plurality of surgical fasteners retained with in thefastener cartridge 2012 to causes ejection thereof.

The tool assembly 1004 (FIG. 1) may also be adapted for use with asurgical stapling apparatus 3000 (FIG. 11), such as that disclosed incommonly assigned U.S. Pat. No. 7,334,717, currently assigned to TycoHealthcare Group LP, the contents of which are hereby incorporated byreference herein in its entirety. The surgical stapling apparatus 3000includes a cartridge receiving half-section 3002, which accommodates aplurality of surgical fasteners, and an anvil half-section 3004. Thehalf-sections 3002, 3004 are pivotally connected via handles 3006, 3008for approximation during use.

Following approximation of the half-sections 3002, 3004, the surgicalfastener applying apparatus 3000 is fired by driving a firing slide 3010distally through the advancement of a firing lever 3012. Distal movementof the firing slide 3010 causes a plurality of cam bars to engagecamming surfaces that interact with a plurality of pushers to expel theplurality of surgical fasteners from the cartridge receivinghalf-section 3002. The surgical fasteners are positioned on either sideof a track which guides a knife during longitudinal movement to therebysever tissue along a cut-line.

The tool assembly 1004 (FIG. 1) may also be adapted for use with atransverse anastomosis fastening instrument 4000 (FIG. 12), such as thatdisclosed in commonly owned U.S. Pat. No. 5,964,394, currently assignedto United States Surgical Corporation, the contents of which are herebyincorporated by reference herein in its entirety. The surgical fastenerapplying apparatus 4000 includes an approximation lever 4001, a movablehandle 4002, an elongated portion 4004 that extends distally from thehandle 4002, and an arm 4006 that extends from a distal end 4008 of theelongated portion 4004. The surgical fastener applying apparatus 4000further includes a tool assembly 4010 that includes an anvil 4012 thatis orthogonally affixed to the arm 4006, and a surgical fastenercartridge receiver 4014 that is operatively coupled to the distal end4008 of the elongated portion 4004 for retention of the surgicalfastener cartridge 200.

Prior to firing of the surgical fastener applying apparatus 4000, theapproximation lever 4001 is actuated to distally advance a drive memberthat is operatively connected to the surgical fastener cartridge 200 tomove the surgical fastener cartridge 200 towards the anvil 4012, whichremains stationary, and capture tissue therebetween. Thereafter, thehandle 4002 is moved to advance a pusher bar distally through theelongated portion 4004 to cause corresponding movement of a head portionincluded at the distal end of the pusher bar. The head portion includesa plurality of fingers extending distally therefrom that are configuredand dimensioned to engage the cartridge assembly to thereby dischargethe plurality of surgical fasteners retained therein. Upon discharge,the surgical fasteners are driven through the tissue and into the anvil4012 for formation.

It is also envisioned that the tool assembly 1006 (FIG. 1) may also beadapted for use with any of the other surgical fastener applyingapparatus discussed in commonly owned U.S. Pat. Nos. 6,045,560;5,964,394; 5,894,979; 5,878,937; 5,915,616; 5,836,503; 5,865,361;5,862,972; 5,817,109; 5,797,538; and 5,782,396, the disclosures of whichare hereby incorporated by reference herein in their entirety.

In additional embodiments of the present disclosure, the surgicalfastener applying apparatus may include a plurality of cam bars forinteracting with the pushers to deploy the surgical fasteners. Forexample, the surgical fastener applying apparatus disclosed in U.S. Pat.No. 5,318,221, the disclosure of which is hereby incorporated byreference herein, in its entirety, has a cam bar adapter that holds aplurality of cam bars and a knife. A channel is advanced throughoperation of the handle of the apparatus, which drives the cam bars andknife forward. A clamp tube that surrounds the proximal end of the anvilis advanced to clamp the anvil and cartridge together. In anotherexample, the surgical fastener applying apparatus disclosed in U.S. Pat.No. 5,782,396, the disclosure of which is hereby incorporated byreference herein, in its entirety, has an actuation sled. An elongateddrive beam is advanced distally through operation of the handle of theapparatus, driving the actuation sled forward. The distal end of thedrive beam engages the anvil and the channel that supports the cartridgeas the drive beam travels distally, to deploy the staples and clamp theanvil and cartridge together.

In a further embodiment of the present disclosure, FIG. 16 shows across-sectional view of a tool assembly 2004 having an anvil member 2100and cartridge assembly 2200. The fastener retention slots 2216 in theouter rows are sized to allow the surgical fasteners 100 to exit theslots 2216 at an angle. The anvil member 2100 has a plurality of formingrecesses 2316 for each slot 2216, to ensure formation of the fastener atone or more angled positions with respect to the vertical axis “Z-Z” ofthe surgical fastener cartridge 2202. The fastener retention slots 2216in the inner rows, adjacent the longitudinal knife slot 2217 of thesurgical fastener cartridge 2202, are sized so that the surgicalfasteners 100 exit the retention slots 2216 in a substantially verticalorientation, i.e., along the vertical axis “Z-Z,” or at a smaller anglewith respect to the vertical axis “Z-Z,” as compared to the surgicalfasteners 100 in the outer rows of fastener retention slots 2216. Thesurgical fasteners 100 in each row of fastener retention slots 2216 maybe the same size, or alternatively, the surgical fasteners 100 in the inthe outer rows of fastener retention slots 2216 may be larger in sizewhen compared to the surgical fasteners 100 in the inner rows offastener retention slots 2216. For example, the surgical fasteners 100in the in the outer rows of fastener retention slots 2216 may havelonger leg lengths when compared to those of the surgical fasteners 100in the inner rows of fastener retention slots 2216. The tendency oftissue to extrude in a laterally outward direction with respect to thecartridge body 2202 will encourage the surgical fasteners 100 to angleoutwardly, as shown in FIG. 16.

In certain embodiments, the anvil member 2100 is comprised of aplurality of plates 2130, each having defined therein forming recesses2316, as shown in FIGS. 17 and 18. The plates 2130 are attached to oneanother so as to form the anvil member 2100, e.g., via lamination. Theforming recesses 2316 may be arranged so that more than one formingrecess 2316 corresponds to a fastener retention slot 2216. In this way,a surgical fastener 100 exiting a fastener retention slot 2216 will bedirected into, and formed by, one of the forming recess 2316, whetherthe surgical fastener 100 exits the fastener retention slot 2216 in asubstantially vertical, or angled, fashion.

The above description, disclosure, and figures should not be construedas limiting, but merely as exemplary of particular embodiments. It is tobe understood, therefore, that the disclosure is not limited to theprecise embodiments described, and that various other changes andmodifications may be effected by one skilled in the art withoutdeparting from the scope or spirit of the disclosure. Additionally,those skilled in the art will appreciate that the elements and featuresillustrated or described in connection with one embodiment can becombined with those of another, and that such modifications andvariations are also intended to be included within the scope of thepresent disclosure.

What is claimed is:
 1. A surgical fastener applying apparatuscomprising: an anvil member; a cartridge member coupled to the anvilmember, the cartridge member defining a longitudinal axis and includingsurgical fasteners; a channel located in the cartridge member along thelongitudinal axis; and a pusher including a base portion and pusherplates connected to the base portion, the pusher positioned within thecartridge member and repositionable to eject the surgical fasteners fromthe cartridge member into the anvil member such that two differentcompressive forces are applied to tissue disposed between the anvilmember and the cartridge member, one of the pusher plates being parallelwith respect to the channel and another of the pusher plates defining anangle with respect to the channel.
 2. The surgical fastener applyingapparatus of claim 1, wherein the pusher is of unitary construction. 3.The surgical fastener applying apparatus of claim 1, wherein the pusherand the surgical fasteners are configured and dimensioned such that thecompressive forces are varied along an axis transverse to thelongitudinal axis.
 4. The surgical fastener applying apparatus of claim1, wherein first and second pusher plates extend from the base portionto define respective first and second lengths, the second lengthdifferent from the first length.
 5. The surgical fastener applyingapparatus of claim 1, wherein the pusher plates are interconnected viathe base portion.
 6. The surgical fastener applying apparatus of claim1, wherein one of the pusher plates is laterally repositionable relativeto channel during movement of the pusher.
 7. An end effector for asurgical stapling instrument comprising: an anvil member; and acartridge member, the cartridge member having: a channel extending alonga longitudinal axis of the cartridge member, surgical fasteners disposedin retention slots, a pusher having a base portion with pusher platesextending therefrom, the pusher being movable to urge the surgicalfasteners towards the anvil member, wherein adjacent pusher platesdefine a gap therebetween, the gap varying between a top portion of theadjacent pusher plates and the base portion of the pusher.
 8. The endeffector of claim 7, further including first and second rows ofretention slots.
 9. The end effector of claim 8, wherein the anvilmember has pockets for receiving legs of the surgical fasteners.
 10. Theend effector of claim 9, wherein surgical fasteners in the first row ofretention slots define a first value of compression upon formation andsurgical fasteners in the second rod of retention slots define a secondvalue of compression upon formation that is different from the firstvalue of compression.
 11. The end effector of claim 10, wherein thefirst value of compression is greater than the second value ofcompression.
 12. The end effector of claim 7, wherein the gap betweenadjacent pusher plates varies as the pusher is moved towards the anvil.13. The end effector of claim 7, wherein one of the pusher platesdefines an acute angle with respect to a tissue contacting surface ofthe cartridge member.
 14. The end effector of claim 7, wherein twopusher plates define two different acute angles with respect to thechannel.
 15. The end effector of claim 10, wherein the surgicalfasteners in the first row of retention slots have a first leg lengthand the surgical fasteners in the second row of retention slots have asecond leg length that is different from the first leg length.
 16. Theend effector of claim 15, wherein the first leg length is less than thesecond leg length.